Predicting Survival with Mobile ECMO: A Single-Center Evaluation

Abstract

Extracorporeal membrane oxygenation (ECMO) treats acute reversible severe heart/lung failure in adults at high mortality risk. While often initiated in-hospital, ECMO's portability allows for experienced centers to implant it off site. We examined the impact mobile ECMO on survival in patients with severe cardiopulmonary failure. This is a retrospective review of patients with in-hospital or mobile ECMO from January 2013 to October 2019. Participants were included if they were ≥ 18 years old and received ECMO performed at Hartford Hospital or through the mobile, "ECMO on the Go" unit. The Survival After Veno-Arterial ECMO (SAVE) and Respiratory ECMO Survival Prediction (RESP) scores were calculated. The primary endpoints were 48-hour and hospital discharge survival. We included 201 patients with a median (25th, 75th percentile) age 54.0 (39.5, 64.0) years and median ECMO time of 5.0 (3.0, 8.0) days. VA (median SAVE score -6.5 [-9.0, -3.0]) and VV ECMO (median RESP score 2.0 [-1.0, 5.0]) were initiated in 51.7% and 48.3% of patients, respectively. Mobile ECMO was initiated in 61 (30.3%) patients. 48-hour survival was higher in the mobile (65.6%) vs hospital ECMO patients (55.7%, p=0.192). Survival to hospital discharge was also higher with mobile (59.0%) vs hospital ECMO patients (41.4%, p=0.097). Baseline SAVE and RESP scores were higher in patients surviving to 48-hr and hospital discharge (p<0.006 for all)(Figure). We showed that mobile ECMO is effective for treatment of severe cardiopulmonary failure refractory to standard modalities. Mobile ECMO trended towards improved survival compared with in-hospital initiation. SAVE and RESP scores may be predictive of survival using mobile ECMO applications.